Empleo de servicios privados de vacunación por lactantes en municipios brasileños: Encuesta Nacional de Cobertura Vacunal 2020

Burdinski, Ediane de Fátima Mance; Denardin, Maiara Sulzbach; Marins, Gisele; Otero, Sandra Duran; França, Ana Paula; Moraes, José Cássio de; Luhm, Karin Regina; ,; Silva, Adriana Ilha da; Ramos Jr., Alberto Novaes; França, Ana Paula; Oliveira, Andrea de Nazaré Marvão; Boing, Antonio Fernando; Domingues, Carla Magda Allan Santos; Oliveira, Consuelo Silva de; Maciel, Ethel Leonor Noia; Guibu, Ione Aquemi; Mirabal, Isabelle Ribeiro Barbosa; Barbosa, Jaqueline Caracas; Lima, Jaqueline Costa; Moraes, José Cássio de; Luhm, Karin Regina; Caetano, Karlla Antonieta Amorim; Lima, Luisa Helena de Oliveira; Antunes, Maria Bernadete de Cerqueira; Teixeira, Maria da Gloria; Teixeira, Maria Denise de Castro; Borges, Maria Fernanda de Sousa Oliveira; Queiroz, Rejane Christine de Sousa; Gurgel, Ricardo Queiroz; Barata, Rita Barradas; Azevedo, Roberta Nogueira Calandrini de; Oliveira, Sandra Maria do Valle Leone de; Teles, Sheila Araújo; Gama, Silvana Granado Nogueira da; Mengue, Sotero Serrate; Simões, Taynãna César; Nascimento, Valdir; Araújo, Wildo Navegantes de

doi:10.1590/S2237-96222024v33e20231203.especial2.en

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 33 (spe2) • 2024 • https://doi.org/10.1590/S2237-96222024v33e20231203.especial2.en linkcopiar

Empleo de servicios privados de vacunación por lactantes en municipios brasileños: Encuesta Nacional de Cobertura Vacunal 2020

Autoría SCIMAGO INSTITUTIONS RANKINGS

Objetivo Caracterizar el empleo de servicios privados en la vacunación de lactantes y evaluar la cobertura vacunal según el servicio utilizado.

Método Encuesta nacional de vacunación realizada en 2020, que estimó la utilización de servicios privados y cuberturas vacunales de lactantes residentes en capitales y 12 ciudades del interior.

Resultados De los 37.801 participantes, 9.287 (25,1% IC₉₅% 23,2;27,2) utilizaron alguna vez servicios privados, con mayores proporciones en capitales, ciudades más grandes y regiones Sur y Sureste. Se identificaron diferencias socioeconómicas y demográficas en las familias, según servicio utilizado. La cobertura del conjunto de vacunas administradas hasta 24 meses fue 60,3% (IC₉₅% 58,6;62,0) en servicios públicos y 59,5% (IC₉₅% 55,9;63,0) en privados, y de vacunas al día 10,3% (IC₉₅% 9,1;11,6) y 9,4% (IC₉₅% 7,4;11,8) respectivamente.

Conclusión El uso de servicios privados fue frecuente, con baja cobertura para el conjunto de vacunas, independientemente del tipo de servicio utilizado, específicamente para vacunas al día.

Palabras clave
Cobertura de servicios sanitarios privados; Cobertura de vacunación; Vacunas; Encuestas Epidemiológicas

Use of private vaccination services	Yes (9,287)			No (28,514)			p-value
Use of private vaccination services	N	%	95%CI	n	%	95%CI	p-value
Characteristics of infants
Sex							0.230
Masculine	4,769	49.4	46.3;52.5	14,638	51.6	49.9;53.2
Feminine	4,518	50.6	47.5;53.7	13,876	48.4	46.8;50.1
Birth order							< 0.001
First-born	5,589	61.8	58.6;65.0	12,670	43.0	41.2;44.9
Second-born	2,977	29.7	26.7;32.8	9,113	31.7	30.3;33.1
third-born	553	6.5	4.9;8.5	4,155	15.0	13.9;16.1
Fourtd-born or later	157	2.0	1.2;3.1	2,553	10.2	9.0;11.5
Maternal characteristics
Schooling (in years of study)							< 0.001
≤ 8	115	1.4	0.9;2.2	3,165	20.0	9.9;12.1
9-12	231	3.4	2.4;4.9	5,263	19.6	18.0;21.2
13-15	1,478	17.6	15.2;20.1	13,859	49.3	47.4;51.1
≥ 16	7,311	75.9	72.7;78.6	5,326	16.8	15.3;18.4
Don’t know/didn’t answer	152	1.7	1.1;2.5	901	3.3	2.7;3.9
Number of living children							< 0.001
One	4,317	49.1	45.6;52.7	10,024	33.3	31.7;35.0
Two	3,965	39.2	35.7;42.8	10,062	35.7	33.9;37.4
three	776	9.1	7.2;11.5	5,035	17.7	16.4;19.1
Four or more	220	2.5	1.7;3.6	3,594	10.5	9.4;11.8
Age at the child’s birth (in years)							< 0.001
≤ 20	30	3.6	0.2;0.6	832	3.1	2.5;3.7
20-34	2,920	29.7	26.7;32.8	18,797	64.1	62.5;65.8
≥ 35	6,302	70.0	66.8;72.9	8,729	32.8	31.1;34.4
Don’t know/didn’t answer	26	4.5	0.1;1.5	156	0.5	0.3;0.7
Marital status							< 0.001
With partner	8,266	88.4	86.2;90.3	19,975	69.3	67.7;70.8
Without a partner	856	9.7	8.0;11.6	7,543	27.3	25.8;28.8
Don’t know/didn’t answer	165	1.9	1.2;2.9	996	3.4	2.9;4.0
Paid work							< 0.001
Yes	6,882	72.8	69.7;75.8	13,564	47.0	45.4;48.6
No	2,259	25.7	22.8;28.7	14,161	50.2	48.6;51.7
Don’t know/didn’t answer	146	1.5	0.9;2.3	789	2.8	2.3;3.4
Race/skin color							< 0.001
White	6,365	69.9	66.3;73.3	8,862	36.2	34.0;38.5
Black	375	6.0	4.3;8.4	3,880	14.7	13.5;16.0
Mixed-race	2,252	20.5	19;23.1	14,607	44.7	42.8;46.7
Asian	129	2.1	1.3;3.3	239	1.2	0.7;1.9
Indigenous	10	0.0	0.0;0.1	115	0.4	0.2;0.5
Don’t know/didn’t answer	156	1.4	0.9;2.2	811	0.3	2.2;3.3
Family characteristics
Socioeconomic stratum of the area of residence							< 0.001
A	3,642	27.2	23.0;31.9	4,691	6.7	5.6;7.9
B	2,897	22.0	18.4;26.0	6,521	8.9	7.7;10.3
C	2003	25.8	21.9;30.0	7,989	19.17	17.3;21.1
D	745	24.9	20.8;29.5	9,313	65.2	62.3;68.0
Household consumption level							< 0.001
A	1,645	14.4	11.9;17.4	290	0.8	0.6;1.2
B	5,135	52.0	48.0;55.7	3,866	11.3	10.0;12.6
C	1,747	22.4	19.3;25.7	9,868	37.6	35.6;39.6
D	488	7.8	6.1;9.9	13,520	46.8	44.7;49.0
Don’t know/didn’t answer	272	3.4	2.4;4.9	970	3.5	2.9;4.1
Monthly household income (in BRL)							< 0.001
≤ 1,000	359	6.7	5.1;8.6	8,327	32.9	30.8;35.1
1,000-3,000	1,115	13.6	11.1;16.6	11,551	40.9	38.8;43.1
3,000-8,000	2,718	25.2	22.0;28.7	4,741	13.0	11.7;14.4
≥ 8,001	3,646	29.6	26.1;33.4	974	2.3	1.9;2.9
Don’t know/didn’t answer	1,449	24.8	20.8;29.4	2,921	10.7	10.0;12.6

Vaccination coverage	Administered vaccines			Up-to-date vaccines
Vaccination coverage	Private (%)	Public (%)	p-value	Private (%)	Public (%)	p-value
Brazil
Total	59.5	60.3	0.704	9.4	10.3	0.473
Municipality type
Inland city	64.6	61.7	0.538	10.6	10.9	0.885
Capital	59.2	60.1	0.656	9.3	10.2	0.492
Municipality size (per/thousand inhabitants)
150-900	54.6	57.8	0.211	7.1	6.5	0.633
>900	60.8	61.3	0.859	10.0	11.8	0.274
Regions
North	53.8	55.7	0.762	0.7	3.0	0.034
Northeast	50.7	58.6	0.122	5.8	9.0	0.098
Midwest	61.3	63.5	0.539	10.0	10.7	0.694
Southeast	61.1	60.3	0.824	11.6	13.6	0.410
South	67.1	68.4	0.753	9.0	10.0	0.675

Vaccine	Administered vaccines			Up-to-date vaccines
	Public	Private	p-value	Public	Private	p-value
	% (95%CI)	% (95%CI)	p-value	% (95%CI)	% (95%CI)	p-value
Up to 12 months old
First dose of tuberculosis vaccine	89.6 (87.3;91.5)	89.8 (88.5;91.0)	0.839	82.3 (79.3;85.0)	84 (82.6;85.4)	0.293
First dose of hepatitis B vaccine	89.3 (87.0;91.2)	88.6 (87.2;89.8)	0.537	86 (83.5;88.3)	85.5 (84.1;86.9)	0.756
Second dose of 10 valent pneumococcal vaccine	91.1 (89.0;92.8)	90.2 (89.0;91.3)	0.407	78.7 (78.8;81.3)	66.3 (64.4;68.0)	< 0.001
Second dose of human rotavirus vaccine	83.6 (80.7;86.1)	81.7 (80.3;83.1)	0.248	72.8 (69.2;76.0)	64.5 (62.7;66.4)	< 0.001
Second dose of meningococcal C vaccine	89.8 (87.7;91.5)	89.3 (88.1;90.4)	0.663	70.9 (67.8;73.8)	58.7 (56.7;60.7)	< 0.001
third dose of the pentavalent vaccine	86.7 (84.0;89.0)	88.6 (87.3;89.8)	0.148	66.1 (62.8;69.3)	53 (50.8;55.2)	< 0.001
third dose of inactivated polio vaccine	86.3 (83.6;88.6)	88.6 (87.3;89.8)	0.084	66.8 (63.3;70.0)	55.5 (53.5;57.5)	< 0.001
12-24 months old
First booster of 10 valent pneumococcal vaccine	86.1 (83.4;88.4)	84.7 (83.3;85.9)	0.309	65.7 (62.6;68.7)	51.5 (49.7;53.3)	< 0.001
First booster of meningococcal C vaccine	84.0 (81.4;86.3)	81.6 (80.2;82.8)	0.108	48.0 (45.1;51.3)	47.4 (45.5;49.3)	0.229
First dose of hepatitis A vaccine	89.6 (87.4;91.4)	87.7 (86.4;88.9)	0.112	56.5 (53.3;59.7)	49.3 (47.7;50.9)	< 0.001
Second dose of MMR (measles, mumps and rubella) vaccine	84.3 (81.2;87.0)	81.5 (80.1;82.9)	0.103	39.8 (36.3;43.4)	42.7 (41.0;44.0)	0.019
First booster of oral poliovirus vaccine	84.4 (81.8;86.8)	86.9 (85.6;87.9)	0.078	39.5 (36.5;42.6)	44.3 (42.5;46.1)	0.039
First booster of DTP (diphtheria, tetanus and pertussis) vaccine	82.9 (80.2;85.3)	84.7 (83.4;85.9)	0.218	37.1(33.9;40.4)	37.2 (35.4;39.0)	0.427
First dose of chickenpox vaccine	89.3 (87.1;91.1)	86.3 (84.9;87.6)	0.019	57.2 (54.0;60.3)	44.1 (42.4;45.9)	< 0.001

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Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 (61) 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] a) Yes: participants who have used private vaccination services at least once; No: participants who exclusively used public vaccination services.